My Response to the Care Quality Commission

My Response to the Care Quality Commission

I received a letter back in December from the CQC regarding my “experience of receiving care and treatment at the Charing Cross Gender Identity Clinic”. This was my response.

Ref: INS1-2206743716


I’d like to tell you about my experience of Charing Cross Gender Identity Clinic. I was referred to them early in 2014. I heard nothing for months and phoned the clinic a couple of times to make sure that they had received my referral. I finally had my first assessment (with Dr. Lenihan) in December of that year – about a 9-10 months wait.

After seeing her, on my way out I made an appointment for my second assessment in May 2015 with Dr. Lorimer. At the time, given how long I had waited for my first appointment, I thought a mere five month wait wasn’t too bad!

However, a few weeks before the date I received a phone call from the clinic telling me that the doctor was unavailable due to a holiday and they would have to cancel my appointment. It’s difficult to express just how crushing a blow this was. I had expectations of finally getting approval for the treatment that would allow me to move forward with my life and for that to be taken away from me was devastating.It triggered months of severe depression, affecting my physical health, my work and the relationship with my wife. Things only started to improve after I finally received a letter giving me a new date to see Dr Lorimer, on January 15th (last Friday).

So, I turned up at the clinic (45 minuted early because of the vaguaries of public transport into London) only to be told that I didn’t have an appointment: hadn’t I gotten the message the week before telling me that it had been cancelled (again!).

Obviously I hadn’t got the message; there’s no way I’d endure the travel into London just for fun! I don’t think it’s acceptable to simply leave a voicemail with no guarantee that it will be picked up. For me communication by letter or email would be better (I have anxiety issues using the phone and don’t pick up calls where the number is withheld or unknown to me; I also do not answer calls during work hours).

Anyway, I’m currently here, over 13 months since my first assessment, fighting depression again with no end in sight for this limbo I find myself in. Given what I was told by the admin staff about Dr. Lorimer’s health problems I really can’t see at the moment that I’ll ever progress to the point where I can begin to receive treatment (HRT, surgery). All this waiting is beyond unreasonable.

I don’t think the woefully inadequate level of service provision for trans people is in any way acceptable. In what other sector of the health service would such waiting times be remotely acceptable, especially given the hugely detrimental effect it has on people’s well-being and quality of life?


Alex Forshaw (Ms.)

One Step Closer

One Step Closer

One week ago today I was in London attending my first appointment at the Charing Cross Gender Identity Clinic with one of their resident psychiatrists.

Although I was excited by the prospect of getting one step closer to accessing medical treatments for my Gender Dysphoria, I’d not been looking forward to traveling up there by train. I find using public transportation particularly stressful even when I’ve planned the journey meticulously: being confined in a small space with a group of strangers for a length of time causes me anxiety.

I worked until 11 am and then drove home via a store to pick up something quick and simple for my lunch during a brief stop at home before freshening up my makeup and heading out again to Farnborough, leaving myself plenty of time to park, walk to the station and buy my ticket. So far so good! The train arrived 15 minutes after I had taken a seat on the platform to wait, and I boarded along with several other people.

The carriage was about half-filled and I managed to find a seat next to a window. I much prefer to spend the journey staring out the window rather than risk making inadvertent eye contact with some person as I glance around inside the carriage.

It was about 45 minutes later that the train arrived at London Waterloo where I had to head to the Tube station to continue my journey. I don’t enjoy using the Tube, but it’s preferable to either the expense of a taxi or the uncertainty of trying to navigate bus routes. The only thing I do enjoy about the Tube is thoughts of Neil Gaiman’s Neverwhere that are evoked by the names of the stations as I pass through them or see them on the maps: Knightsbridge, Earl’s Court, Blackfriars.

One change at Piccadilly Circus and I arrived at Barons Court, the closest Tube station to the clinic. A short walk (0.7 miles according to Google maps) brought me to the clinic and I pressed the door buzzer to be let in. Through the door, up the stairs, through another door and there I was at the reception desk.

I handed my appointment letter to the receptionist and confirmed my details (name, home address, doctor) before being asked to take a seat in the waiting area. I had a little trouble picking up what the receptionist said because she wasn’t facing me as she spoke, instead looking down at the paperwork on her desk, and had to ask her to repeat herself a couple of times. I rely on lip reading to a degree when somebody is speaking so that I can better make out the words.

I sat down. I had arrived half an hour before my appointed time, which allowed me to sit and relax after the journey. I let my mind wander, daydreaming, and it seemed that very little time had passed when I heard my name called by the psychiatrist I was due to see. I followed her to her room and she began my assessment.

I was a little nervous at the start, but the opening question, “Why are you here today?” was easy enough to answer since it is something I have been thinking about since before I came out last year. The questions were quite comprehensive and covered my medical history, family, home and work situations, and my experience of gender non-conformity up to and including transitioning.

We established my priorities for treatment (facial hair removal, hormones, genital surgery, voice feminization) and I was pleasantly surprised when she said that they could apply for funding to cover electrolysis or laser hair removal. I guess it’s because it’s such a major issue for me: I had no hesitation in identifying it as number one on my list because it’s the thing I focus on every time I look in a mirror.

Hormone treatment came second because I need the changes they bring to body shape (breast development and redistribution of body fat) to reduce the gap between my self-image and my physical reality. Genital surgery was a definite yes, although it was only when she asked directly about the mechanics of sex between me and Anne that I actually realized how much of an obstacle the wrong genitalia has become.

Voice coaching was not something I had thought much about. I had largely resigned myself to getting called “sir” on the phone. It got added to the list after I talked about how I used to enjoy singing karaoke now and again, but haven’t felt able to do so since I transitioned because my voice has too low a pitch. I joked that I’d never be singing soprano whatever happened, to which she responded that I might be surprised how much a voice can change. I decided then that it was definitely worth a try.

That completed my first assessment. I was asked to make an appointment for my second assessment (with a different clinician) which will be in 6 months time, and sent for blood tests at the neighboring Charing Cross Hospital. Once they had drawn the blood samples it was all over, time to head home.

It all seemed to go very smoothly. There was no hint of judgement in relation to my expression of my gender identity, my age at transition, my sexual orientation, my depression, anxiety or poorly-developed social skills. I simply responded to the questioning and put across how I felt about the mismatch between my physical body and my gender identity. In other words, the reasons why I need medical treatment.

The journey home was difficult. It was the middle of rush hour (5:30 pm) with thousands of people crowding the trains and station concourse. It was only my determination and desire to get back home that stopped me from finding some cafe to sit and wait for everywhere to become less crowded. It was standing room only on the train out of Waterloo, passengers filling the aisles with barely six inches between me and the people around me. Luckily the majority of passengers left the train at the first stop, the commuter town of Surbiton, and I could sit for the rest of my journey.

It was with relief that I stepped from the train on arriving at Farnborough, and despite the light rain I enjoyed the walk to where I had parked my car. Getting into my car felt so good. I was finally back in my own space, able to relax and feel safe. The roads were not busy and it didn’t take long to drive home where I could put my feet up, relax with a glass of cider and spend the remainder of the evening with Anne: that was when I realized just how tired I was.

It took a couple of days before I completely got over the exhaustion from the traveling, but it was well worth it to progress past another milestone on my path to fully realizing my identity.